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Insomnia—Behavioral Treatments 

Insomnia—Behavioral Treatments
Chapter:
Insomnia—Behavioral Treatments
Author(s):

Sheila N. Garland

, Ivan Vargas

, Michael A. Grandner

, and Michael L. Perlis

DOI:
10.1093/med/9780190929671.003.0010
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date: 26 February 2021

Insomnia is a disorder with significant psychiatric comorbidity. This chapter provides an overview of how to assess and treat insomnia in patients with comorbid psychiatric disorders using cognitive behavioral interventions. First, the authors review the theoretical framework for the behavioral and cognitive perspectives regarding the etiology of chronic insomnia. They then provide a step-by-step guide for the assessment of insomnia, including the use of validated measures and the necessary components of a semi-structured clinical interview needed to identify predisposing, precipitating, and perpetuating factors while at the same time paying attention to possible comorbidities and differential diagnostic possibilities that may better explain the patient’s difficulty. How to treat insomnia using cognitive behavioral therapy for insomnia (CBT-I) techniques of stimulus control therapy and sleep restriction therapy with formal cognitive restructuring in order to target arousal, dysfunctional behaviors and maladaptive thoughts, beliefs, and attitudes is explained. The authors discuss a number of contemporary issues with the delivery of CBT-I including the concurrent use of sleeping medications, the limitations and side effects of CBT-I, and alternative CBT-I delivery models. Further, the chapter examines the efficacy and effectiveness data for CBT-I in patients with psychiatric comorbidities. Lastly, the chapter presents a case example of CBT-I delivery in a patient with insomnia and comorbid major depressive disorder. The authors conclude with recommendations for future research.

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